Objective
To analyze the resource allocation, indications, and clinical utilization of continuous renal replacement therapy (CRRT) in ICUs, and provide references for the development of relevant policies regarding the application of CRRT in ICU settings.
Methods
A cross-sectional survey from a total of 167 hospitals in 5 provinces from the eastern, central, and western regions of China from March 1 to 31, 2021 was conducted based on literature research and expert consultation, resulting in the creation of a questionnaire on the current application status of CRRT in medical institutions (ICU).The contents of the questionnaire mainly include:(1) resource allocation in each region (medical staff allocation and training of CRRT equipment configuration,management and operation of CRRT technology); (2) composition of indications (kidney disease and non-renal disease); (3) clinical application (treatment mode and treatment duration, use of replacement fluid and filter, regular quality control and disinfection measures); and (4) treatment effect (patient prognosis and treatment cost).
Results
In terms of resource distribution, CRRT equipment resources and human resources were more abundant in the eastern part of China, and the proportion of healthcare personnel who had participated in the standardized training on CRRT organized by national or provincial societies/associations was relatively low (38.54%-62.70% for physicians;18.86%-35.26% for nurses); in terms of clinical use, indications for CRRT in ICUs were predominantly for nonrenal diseases, with the top 3 indications were sepsis or infectious shock (17%), followed by acute (13%) or chronic(12%) renal insufficiency combined with circulatory instability, and there was little difference in the distribution of the top indications across the region; the 2 treatment modes with the most applications were CVVHDF (37%)and CVVH (33%); the duration of CRRT treatment in each province spanned a wide range, but with a sub-average treatment duration of ＞24 h (59.3%); on the whole, more commercial replacement solutions (65.44%) were used than handmade replacement solutions (34.56%), but the proportion of handmade replacement solutions was higher in some regions (＞50% in Jiangsu and Xinjiang); the frequency of filter replacement was affected by the mode of anticoagulation, and the highest frequency of filter replacement was found in the case of no anticoagulation (about 10.50 h/times), and the service life of the filter was longer in the case of anticoagulation with citrate (about 26.65 h/times).In terms of treatment effect, the overall case fatality rate of patients during hospitalization in ICU was 21.40%, and the proportion of patients still needing long-term dialysis after CRRT treatment was 20.19%, with a significant difference in treatment effect between Henan and Xinjiang and other regions; in terms of treatment cost,there was a big difference in the charges of CRRT in various regions, with a range of 80-130 yuan/h.The average cost of hospitalization for CRRT patients was 74 000/person, of which CRRT-related costs account for about 20%,and the reimbursement ratio of medical insurance was higher (about 70% overall); the fee schedule usually included healthcare personnel hourly fee, machine depreciation fee, and replacement fluid (accounting for ＞50% of the total), while anticoagulant and hemodialysis tubing were usually not included in the fee schedule (accounting for＜30% of the total), of which the price of dialysis tubing was higher, which had a greater impact on the overall cost.
Conclusion
In the future, coordinated planning of CRRT technical resources, promotion of standardized management of procedures, and establishment of quality control systems will be needed to achieve the goal of improving the quality and efficiency of medical institutions and intensive care departments.